'Supporting people to reconstruct their lives as soon as possible helps alleviate the stress that can lead to psychological problems'

Professor Richard Bryant FAPS, from the University of New South Wales, is a world expert in psychological response to trauma who has direct experience with floods after working on disaster recovery in New Orleans after Hurricane Katrina and the ensuing storm surges, and in Asia after the Tsunami.

What are some of the unique challenges that floods bring to communities, compared to other disasters like bushfires or cyclones?

In contrast to other recent disasters, the majority of people affected by the floods in Queensland and Victoria did not have their safety directly affected. Yet thousands were directly affected by loss and damage to property and valuables, which can often lead to delayed impacts. People needing to rebuild, or rely on insurance claims to assist their recovery, may have adjustment difficulties for years after the event.

The majority of disaster research tells us that mental health problems typically reduce over time. In stark contrast, however, one finding from Hurricane Katrina was that mental health problems actually increased as the years went by. This has been primarily attributed to the wearing down of people's resources for managing the ongoing stress caused by delayed rebuilding, community recovery and ongoing financial strain. Time will tell if similar patterns occur here.

What are some of the key lessons learnt in New Orleans that are very important in helping people to recover well?

In the wake of Hurricane Katrina, an innovative mental health response program was established, called Skills for Psychological Recovery (SPR). SPR was prepared to assist counsellors across the USA in delivering appropriate interventions that addressed the main needs of people after a disaster. This protocol was not intended to be a first response, but rather to assist many people with ongoing problems who were seeking assistance in the weeks and months after Hurricane Katrina. It was not an intervention for people with diagnosable disorders, but rather an intermediate step to address the range of significant psychological issues that typically arise. This program intentionally was based on evidence-supported strategies and included the skills of information gathering, problem solving, emotion management, healthy thinking, positive activities and social connections.

This approach was subsequently adapted following the Black Saturday fires, and resulted in many health professionals being trained across Victoria to assist mid- and longer- term needs of those affected. A key ingredient was that, although instigated by the APS, it was only implemented in close collaboration with the State and Federal Governments, as well as all the other mental health providers. This collaborative approach is essential. By coordinating the many disciplines involved in psychosocial response we reduce previous problems encountered post-disaster where agencies acted autonomously and independently, creating a chaotic recovery environment and thereby minimising the opportunity for any to work optimally.

What are some of the worst times for people after a flood?

There is enormous variability in how and when people respond to emergencies. What we've learnt is important is having a system in place to enable people to access the right sort of assistance when they need it.

Are there some people who might be more at risk of developing significant mental health problems after the floods?

From previous research, we know some people are more vulnerable - those with prior psychological vulnerabilities, or who lost loved ones or significant property, those who were relocated, or those having ongoing financial difficulties. What is key will be managing people who, for legal, financial or bureaucratic reasons, are not able to reconstruct their lives as quickly as others.

What encourages resilience from people in the aftermath?

Again one of the important things is that supporting people to reconstruct their lives as soon as possible helps alleviate the stress that can lead to psychological problems. The other major factor is social support. This is not just having people available, but rather accessing good social support at times when you need it.

Which skills are most useful for psychologists working with people affected by the floods?

From our experience in New Orleans, one of the most frequently used skills people required was simply good problem solving. With so many obstacles that people face every day, being able to appraise problems in a realistic manner, and then proceed with problem solving strategies in a practical way, was seen by many as one of the most useful skills people could learn - or offer.

InPsych February 2011